1235442328 NPI number — ACH WINN-FT STEWART

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235442328 NPI number — ACH WINN-FT STEWART

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACH WINN-FT STEWART
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235442328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 HARMON AVE STE 1D03
Provider Second Line Business Mailing Address:
C/O WINN-THIRD PARTY INSURANCE
Provider Business Mailing Address City Name:
FORT STEWART
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31314-5641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-435-6037
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2451A HWY 17
Provider Second Line Business Practice Location Address:
STATION SHOPPING CENTER
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31324-6422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-435-7118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF, UBO
Authorized Official Telephone Number:
571-801-6238

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1225081136 . This is a "PARENT FACILITY WINN ACH NPI" identifier . This identifiers is of the category "OTHER".




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